Case #529

Laryngectomy always include tracheostomy

Added by Ralph Dahlgren over 3 years ago. Updated over 2 years ago.

Status:AcceptedStart date:2017-02-03
Priority:MinorSpent time:-
Assignee:Ralph Dahlgren
Category:-
Target version:Minor-Proposals-for-2016
Initiator:Sweden Target year:2018
Case type:Minor Owner / responsible:National organisations
MDC:MDC03 Old forum status:
Target Grouper:SWE

Description

Problem
While doing a laryngectomy you always begins with creating a tracheostomy. This is essential for the patient's survival. The clinicians have never coded the procedure code for tracheostomy. We have been informed that this is the case. In Sweden the clinicians while perfroming DQB30 Laryngektomi (Laryngectomy) and DQB50 Hemilaryngektomi (Hemilaryngectomy ) never use the procedure code for tracheostonmy because this is always done at the same time. In Sweden we have a rule that says that a procedure code that would normally be considered as part of another registered procedure should not be registered separately.

The procedure kodes GBB00 Trakeostomi and GBB03 Perkutan trakeostomi are the only ones with grouping property PROCPR 00S03 that will lead to DRG C01 Tracheostomy.
Sweden wants DQB30 Laryngektomi (Laryngectomy) and DQB50 Hemilaryngektomi (Hemilaryngectomy ) also to be grouped to DRG C01 Tracheostomy.

Because of this DQB30 Laryngektomi (Laryngectomy) and DQB50 Hemilaryngektomi (Hemilaryngectomy ) has to have PROCPROP 00S03.

Analysis
The National Board of Health and Welfare, Sweden 2017-02-01.
Drgnamn atgardnamn N vardtid Fall Meancost
C01E Trakeostomi/transpl ÖNH-sjd U Totalt 56 14 Alla 218 090kr
C05N Andra större op huvud & hals Totalt 319 18 Alla 145 398kr
D19C Andra op andningsorg K Totalt 388 7 Alla 91 856kr
D19C Andra op andningsorg K DQB50 Hemilaryngektomi 1 10 Alla 191 403kr
C05N Andra större op huvud & hals DQB30 Laryngektomi 34 18 Alla 219 462kr
As can be seen above the cases with DQB30 and DQB50 cost closer to the other cases in DRG C01 Tracheostomy. As mentioned above they fit better there out of a medical perspective as well.

Suggestion
The National Board of Health and Welfare, Sweden 2017-02-01
Remove Procpro 00S05 Face Mouth from DQB30 and insert Procpro 00S03 Tracheostomy to codes DQB30 and DQB50.
If any other country has any more codes with PROCPRO 00S05 the technical change has to be done differently.
Decided changes
The National Board of Health and Welfare, Sweden 2017-02-01
Sweden wants DQB30 and DQB50 to be redirected to DRG C01 Tracheostomy. This even if the technical changes has to be done differently due to the fact that other countries have more procedure codes with grouping property 00S05.

DRG change
This means that the cases with procedure codes DQB30 and DQB50 will switch from either DRG C05N (049A) or DRG D19C (076C) to DRG C01 (482) Tracheostomy.

Technical change
From a Swedish perspective it is enough to remove Procpro 00S05 Face Mouth from DQB30 and insert Procpro 00S03 Tracheostomy to codes DQB30 and DQB50.
Since in Sweden PROCPRO 00S05 will disappear PROCPROP 00S05 will be deleted out of the definitiontable sheet PROCPROP and in DRG logic we remove 00S05 from two rows. This row gets new ord.

C591 Decision tecnical changes.xlsx (20.2 KB) Anonymous, 2017-02-06 12:26

C591 to Forum.docx (20.3 KB) Anonymous, 2017-02-06 12:26

#529.xlsx - # 529 (12.3 KB) Kristiina Kahur, 2017-02-15 12:44

#529_FIN_tecnical changes.xlsx - #529_FIN_tecnical changes (20.4 KB) Kristiina Kahur, 2017-03-28 13:38

New decision tecnical changes #529, C591.xlsx (19.5 KB) Ralph Dahlgren, 2017-04-12 15:34

Technical changes case #529.xlsx (54.8 KB) Martti Virtanen, 2017-04-19 12:55

Technical changes case #529-2.xlsx (54.4 KB) Martti Virtanen, 2017-12-14 16:53

History

#1 Updated by Anonymous over 3 years ago

#2 Updated by Kristiina Kahur over 3 years ago

Finnish National DRG-centre 2017-2-15

In Finland code DQB30 Laryngectomy has been code 27 times (2015). Code DQB50 Hemilaryngectomy has not been coded.
GBB00 has been coded together with DQB30 three times (out of 27). GBB03 has not been coded while DQB30 has been present.
In terms of cost, the cases with DQB30 are more similar to those of DRG 482, i.e. ca 20 000 EUR vs ca 22 000 EUR.
Finland supports this proposal.

The Finnish cost data and comparison with Swedish one is in attached appendix (# 529)

See separate sheet #529.

#3 Updated by Martti Virtanen over 3 years ago

2017-03-08 Martti Virtanen
This proposal resullts in changes that obviously are not wished by the proposal makers. Removing 05S05 from the rules groups all tracheostomies here. Not just the cases discussed in the proposal.
If laryngectomy and hemilaryngectomy are to be grouped to tracheostomy of ENM they shoud have their onw rule (with a new property) for that.

#4 Updated by Mats Fernström over 3 years ago

Mats Fernström, NPK, Sweden 2017-03-22
We do not understand Martti´s comment. We actually want all cases with DQB30 Laryngectomy or DQB50 Hemilaryngectomy to be grouped to DRG C01/482. The most simple way to achieve that is to add 00S03 to these procedure codes (DQB30 and DQB50). In the Swedish version, procpro 00S05 is then no longer needed since DQB30 is the only code that has 00S05 and therefor the rule in Drglogic with 00S05 in the column secpro can be deleted. This change in Drglogic must not be done, however, if there are other codes with 00S05 in other versions. The rule with ORD 100D400110 in our technical changes must not be inserted because it leads to DRG C01O/482O and that DRG shall be deleted according to the decision in case #454.

#5 Updated by Martti Virtanen over 3 years ago

2017-03-13 Expert group
Waiting for further correction. Will be done for NordDRG 2017 atleast in SWE.

#6 Updated by Martti Virtanen over 3 years ago

2017-03-27 Martti Virtanen
The Swedish proposal combines groups 483M&N/W01A&E 'Tracheostomy except for face, mouth & neck diagnoses...' with 482C/C01C 'Tracheostomy for face, mouth & neck diagnoses w cc or laryngectomy'. The MCC group W01M disappears.
All outpatient tracheostomy cases are combined to 482O/C01O 'Tracheostomy for face, mouth & neck diagnoses, short therapy'. Currently the outpatient tracheostomies are devided between different MDC's, some to specific DRG's (for example trauma), some to rest groups (obviously very rare situations)
(Names are from old version)

The rules for 483/W01 (400D3008001 and 400D300809) become imbossible as well as the rule 400D300609 for 482N/C01E.
The rule 400D300605 for 482C/C01C becomes unnecessary.

DQSB30 (DQB30) and DQSB050 (DQB50) do not need the property 03S01 nor any other properties (than 00S03) since all cases are assigned with the modified rules (includes respiratory and trauma cases).

Which changes do we want?

#7 Updated by Kristiina Kahur over 3 years ago

Finnish National DRG-centre 2017-3-28

If I got it correct, we want a change which allows the cases with DQB30 and DQB50 to group to DRG 482 instead of 049A. At least in Finnish version it seems a reasonable change which is supported By cost analysis.
DRG 483 is not concerned in current case since we talk about the face, mouth and neck diagnosis which are related to DRG 482.

As for Martti’s comments about the necessity of other PROCPROs of DQB30/50 like 03S01 or 00S03, I didn’t get the point, why they are not needed anymore.

I made the technical changes for Finnish version (see appendix #529_FIN_tecnical changes). Would it make sense?

As for outpatient cases of DRG 482O with DQB30/50 codes (in case there is any, there is no single one in Finnish data) should in future (in 2018 version) group to DRG 063O as we discussed and decided in the meeting (see case #454) and as mentioned in Mats’ comment.

#8 Updated by Ralph Dahlgren about 3 years ago

2017-04-12. Sweden has looked at the suggested Changes submitted by Findland. If we in Sweden understood Marttis suggestion correct we should make a new rule in the table DRGlogic with a new Procprop since we want laryngectomy and hemilaryngectomy to be grouped to tracheostomy of Ear Nose and Mouth diseases.
So now we have made new technical Changes that is called "New decision tecnical changes #529, C591.xlsx".

#9 Updated by Kristiina Kahur about 3 years ago

Finnish National DRG-centre 2017-4-13

We would be glad to get Martti's feedback to technical changes made by Finland with respect to correctness. They differ from Swedish ones.
Thanks.

#10 Updated by Martti Virtanen about 3 years ago

2017-03-13 Expert group
Expert group accepted in pinciple the change but the proposed technical changes did not work as expected. Therefore Ralph Dahlgren has made an updated proposal (see above)

#11 Updated by Martti Virtanen about 3 years ago

2017-04-19 Martti Virtanen
The proposal from Ralph is based on the discussion at the expert group meeting and I think the results are those we expected.
I have collected more related information to the technical changes. I think it illustrates that the proposal from Kristiina Kahur does not give the needed results.
The proposals from Sweden and Finland are illustrated in the drglogic sheet of Technical changes. The IN/OUT column indiates that the in change will be inclusion of the Swedish proposal.

#12 Updated by Kristiina Kahur about 3 years ago

Finnish National DRG-centre/Kristiina Kahur 2017-4-19

Thanks for explanation.
I am confident that technical changes provided by Ralph and checked by Martti will work according to proposed change.
We continue to upgrade our competence in making technical changes.

#13 Updated by Martti Virtanen over 2 years ago

2017-12-14 Martti Virtanen
Norway wants to apply this idea also in the NordDRG-Nor.
The definition is added to the rule used by FIN (400D300615)- Nat_ver Fin/Nor

#14 Updated by Martti Virtanen over 2 years ago

  • Status changed from Active to Accepted

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